PATIENTS NOT PASSPORTS: Migrants Access to Healthcare During the Coronavirus Crisis | June 2020 While we have classified these policies and practices as ‘barriers’, they might equally be described as structural weaknesses in the system of care provision. By undermining the relationship between health services and a significant portion of Britain’s migrant and BAME populations, the Hostile Environment has made the NHS less resilient to shocks and emergencies. The World Health Organisation has repeatedly emphasised that long-term management of the pandemic requires the building and maintenance of trust: trust by the public in the decisions made by governments, trust by governments that the rules they set will be adhered to, and clear communication to prevent misunderstanding or lack of clarity on what needs to be done and by whom.22 By its very nature the Hostile Environment undermines trust in public services, removing from Government the most essential mechanism required for fighting the crisis. It is clear that the Hostile Environment is incompatible with the role and functions of the NHS. It works to create and reinforce the perception that certain groups of people are not entitled to access vital public services. Through misinformation and misapplication, and the mobilisation of fear, the policy creates a hostility that discourages people from seeking care. This hostility, and the structural nature of the exclusions it establishes, are likely to have contributed to the disproportionate number of BAME deaths during the coronavirus crisis. The findings of this research demonstrate that current exemptions, as well as the Government’s emergency pandemic policies, are not working. We conclude, in line with recommendations set out by the Lancet Commission on Migration and Health as well as many others, that the only way to address these failures is to end the Hostile Environment in the NHS altogether. This will entail: 1. Withdrawing all NHS charging for migrants, in particular the National Health Service Overseas Visitor Charging Regulations 2015 and 2017 and the Immigration Health Surcharge. 2. Ending all data sharing between the NHS and other health services, and the Home Office. The government should implement a firewall to ensure that patient data will never be shared with the Home Office or other bodies for the purposes of immigration enforcement. 3. Launching an information campaign to ensure both NHS staff and the public are aware of these changes and that it is safe for people to seek care. It should be done with a particular focus on migrant communities across the UK with the intention of undoing the deterrent effects of the Hostile Environment. It should also inform people about their right to access translation services and translated guidance throughout their engagement with the NHS, and impress upon NHS Trusts their requirement to meet this need. These measures are urgently needed. They echo the recommendations made by: the Lancet Commission on Migration and Health, 60 MPs, the Mayor of London, the BMA, six Royal Colleges that represent doctors and midwives, and over 100 civil society organisations.23 They can and should be implemented now to end the Hostile Environment in the NHS and ensure genuinely universal access to healthcare. 28